Ankle Fusion and Replacement

Ankle Arthritis Surgery

Ankle fusion is permanently stiffening the bones of the ankle together with plates and screws. This procedure is also known ankle arthrodesis. 



Dr Beamond performs ankle fusion using three techniques (see images below):

• arthroscopic ankle fusion
• anterior open ankle fusion
• lateral open ankle fusion.



The aim of fusion is to improve pain and function by removing arthritis and joint instability. It is only recommended after non-surgical treatment has failed to improve symptoms. 



A simple way of thinking about fusion is "turning a painful and stiff joint into just a stiff joint".



Most ankle fusions are for arthritis and deformity. A few are done for severe joint instability when no other treatment works. 



Fusion is still the best way of treating severe ankle arthritis when there is bone loss, deformity and/or instability. It is also the correct procedure in most people under 60 years of age. 



Stiffening the ankle does alter gait and can put extra load on the joints around the ankle. Rocker-sole shoe are very useful in reducing these problems. 90% of people have significant pain relief for life after ankle fusion.

Replacing the ankle surfaces with metal and plastic has been available for many years but the results have been nowhere near as good as hip and knee replacement.

Ankle replacement technology continues to develop as our understanding of why these implants fail also develops. Better materials and patient-specific instruments are making the current generation of implants (2015 and beyond) more reliable (see images below).

Only small numbers are performed in Australia (630 in 2023). For comparison, 30000 hip and 33000 knee replacements are performed each year.

Ankle movement after ankle replacement is not normal. Some restriction and stiffness is common. Significant pain relief occurs in 70% of people. 

All joint replacements eventually wear out and "fail". If an ankle replacement needs removing (revision), some are converted to fusion. Re-operation rate (20% at 10 years - for impingement, cysts, etc) and revision rate (15% at 10 years) are still much higher than those of hip and knee replacement (see graph below). Further information is available from the Australian National Joint Replacement Registry .

Ankle replacement is offered to selected people with ankle arthritis. These include low-demand people, those older than 65 years, people with previously fused hindfoot joints, and those with rheumatoid or sero-negative inflammatory arthritis. 

Dr Beamond is trained in this surgical procedure. However, he recommends seeing a surgeon performing this procedure regularly. In SA, Drs Peter Stavrou and Thomas Fisher are options. In Victoria, he recommends Drs Geoff Tymms and David Shepherd, and in NSW, Drs Anthony Cadden and Dean Pepper.